Helping to set professional standards for health staff
Patients are seeing an increasingly diverse range of staff when they use the NHS, including Physician Associates (PAs), who help with some workload within GP practices and hospitals. While Physician and Anaesthetist Associates (AAs) have some medical training, they aren’t doctors.
To help address concerns raised by some patients that they hadn’t been told they were seeing an associate instead of a doctor, we influenced changes by the General Medical Council (GMC) to the set of professional standards it issues to doctors, PAs and AAs. The Royal College of GPs (RCGP) has also used our evidence in new guidance to practices that employ PAs.
What did you tell us?
More than three quarters (76%) of people who answered a national poll we commissioned in April 2024 thought it was important that the person providing their care ‘explains what their job involves’. However, only six in 10 respondents said this was done during their last NHS appointment.
Further evidence shared by local Healthwatch across England showed that in some cases, people felt misled about who they were seeing:
“Told [by a receptionist] you are seeing a physician when it’s a physician associate – one is a doctor and one isn’t.” (Patient story shared by Healthwatch Suffolk)
“I was in a lot of pain and was surprised to be offered an appointment the next day. I specifically asked for a doctor as I wanted to discuss having an operation but when I got there I was told I was seeing a physician’s associate….” (Patient story shared by Healthwatch Richmond)
"I had a phone call then a face-to-face consultation. I presumed I spoke to and saw a GP but when I looked on the website I found that she was a Physician Associate! While I don't mind this I do think it is misleading not to introduce themselves correctly. I should know who I am seeing and exposing my body to!” Patient story shared by Healthwatch Lancashire
What did we do?
In May 2024 we sent a letter, co-signed with other patient bodies, to the General Medical Council, to share our evidence and raise concerns about public confusion over associate roles. We also discussed our concerns with NHS England, which is responsible for workforce planning and the RCGP.
Two months later, we published our evidence and called for practising PAs and those in training to explain their role to all patients they saw. We also asked medical education providers to make clear that informing patients about roles and responsibilities is core to providing high-quality care.
What changed as a result?
In October 2024, the RCGP issued guidance to GP practices, which referenced our findings and stated: ‘It must be made clear to patients that they can ask to see someone other than a PA (indeed this should be offered for all members of the MDT [multidisciplinary team]). If a patient does not want to see a PA, a conversation must take place between patient and practice and a shared decision taken on who will consult with the patient.’
This was followed in December 2024 with a decision by the GMC to update Good Medical Practice – the set of principles, standards and values to be followed by those professionals it regulates. The new requirement states: ‘You should introduce yourself to patients and explain your role in their care.’ The change took effect on the same day the GMC began regulating PAs and AAs, on top of its long-standing role regulating GPs, consultants and other fully qualified doctors.
At the time, the GMC said: “These significant milestones are the result of extensive collaboration with a wide range of organisations representing patients, doctors, PAs, AAs, employers and educators…”
What further action are we taking?
Since December 2024 we have also been a member of a stakeholder advisory group to the Leng Review - an independent, government-commissioned review into the safety and role of physician and anaesthetist associates.
Its chair, Prof Gillian Leng, is considering a wide range of evidence from medical royal colleges, representatives of associates, international experts and Healthwatch and other patient bodies.
Its findings are due to be published in late Spring 2025.
